Physicians in academic medicine make both direct and indirect contributions to the biomedical research enterprise. Physicians make direct contributions through their research activities; roughly half of all National Institutes of Health (NIH) research award dollars to medical schools go to physician principal investigators. Physicians also make indirect contributions through their participation in the education of students in a wide range of health professions and graduate training programs and their service as role models and mentors for these students and trainees. Thus, examining factors associated with both academic medicine career development and NIH-funding receipt, which are related but distinct outcomes, will contribute to our knowledge about factors that broadly promote physician participation in the biomedical research enterprise. Physicians from historically underrepresented minority groups ([URM ]; e.g., Black, Native American/Alaska Native, and any Hispanic) are particularly underrepresented in academic medicine. To develop strategies to increase the diversity of physicians in academic medicine, it is imperative first to identify those factors associated with academic medicine careers that can be targeted for intervention. In our first grant cycle (R01 GM085350; 8- 2008 to 7-2011), we created a database of all 1993-2000 U.S. medical school matriculants (N=129,867) and identified predictors of full-time academic medicine faculty appointment and mediators of racial/ethnic disparities in faculty appointment among graduates in this cohort (18% of white,19% of Asian/Pacific Islander, and 14% of URM graduates held full-time faculty appointments). This competitive renewal application is in response to RFA-GM-12-002. We plan to examine factors associated with 1) promotion and attrition among U.S. medical graduates with full-time academic medicine faculty positions, 2) time to promotion and attrition, and 3) among all graduates, receipt of individual NIH fellowship (F), career development (K), and research (R) grants. We will obtain follow-up data through 2012 for this cohort to update our current database, allowing for examination of factors associated with their careers as academicians and as NIH-funded researchers. Data for our outcomes of interest will be obtained from Association of American Medical Colleges (AAMC) Faculty Roster and NIH individual award receipt records. We will use multivariable regression models to identify factors associated with each of faculty promotion and attrition, faculty appointment among our subset of over 3,000 MD-PhDs (not examined during the first grant period because so many MD-PhDs were still in training), and individual NIH-award receipt. We will examine gender and race/ethnicity differences in time to faculty promotion and attrition using Cox proportional hazard models and Kaplan-Meier curves. The proposed study will make a substantial contribution to the literature about factors associated with the advancement of URM students interested in research along the medical-education continuum from medical school matriculation to their professional development as academicians and as NIH-funded biomedical researchers. PUBLIC HEALTH RELEVANCE: As academic medicine faculty, physicians contribute to the biomedical research enterprise through their activities as biomedical researchers, as teachers for students in a wide range of health professions and graduate training programs, and as role models and mentors for future physicians and researchers. An understanding of the factors that broadly promote the diversity of physicians as academicians and as biomedical researchers is necessary in order to develop the racially and ethnically diverse academic medicine faculty that will best meet national healthcare needs, address ongoing health disparities, and inform the biomedical research agenda for our increasingly demographically diverse American society.